The best way to treat Ebola patients who reach America
Dr. Kent Brantly, an American physician stricken with Ebola, was evacuated this weekend from Liberia to Emory University Hospital in Atlanta, where he will receive treatment for the deadly virus. His colleague Nancy Writebol, also infected with the Ebola virus, returned to the United States on Tuesday. But many Americans have expressed outrage over transport of these Ebola patients into the United States.
This reaction is unjustified — and callous. In the United States, much more can be done for a critically ill Ebola patient than if he or she were on the ground in West Africa. We have intensive care units that allow for careful, continuous monitoring of blood pressure, oxygenation and organ function. Blood pressure may be supported with intravenous fluids and “pressor” medications like norepinephrine, which increase blood pressure. If organs begin to fail when blood pressures are low, we can use ventilators to support breathing or dialysis if kidneys aren’t working. Ebola patients have weakened immune systems and can acquire secondary infections, for which we have a much broader array of antimicrobials at our disposal in the United States.
The likelihood that other Americans could get Ebola from Brantly or Writebol is extremely small. Ebola is not airborne. It is spread through direct contact with a sick patient or infectious bodily fluids. Brantly and Writebol are being treated in a specialized unit, separate from other patients at Emory University Hospital. The healthcare workers staffing this unit will be working in shifts and have access to personal protective equipment. Hospital staff will follow the Center for Disease Control and Prevention’s infection control guidelines for management of contaminated fluids, materials, equipment and surfaces. This is in contrast to working conditions in Guinea, Liberia and Sierra Leone, where the disease has been spreading.
Ebola is a deadly virus for which there is no cure. It kills quickly and dramatically. And it is not the first disease that has inspired fear and stigma. In 1984, Ryan White was diagnosed with AIDS. The thirteen-year-old boy acquired HIV from a blood transfusion for hemophilia. At that time, we knew how HIV was transmitted — through sexual intercourse or blood — yet parents and school officials were afraid that White would transmit HIV to other students by touching them or sharing water fountains. White had to fight in court for his right to go to school.
It is no more likely that Brantly and Writebol’s arrival in the United States will result in an Ebola outbreak than White was to infect his classmates with HIV. There have been five patients with hemorrhagic fevers similar to Ebola in the United States over the last ten years, but none transmitted infection.
Brantly and Writebol became infected with Ebola in the course of heroic work, caring for patients with the virus. Like many other healthcare workers, police officers, fire fighters and soldiers, they were aware of the risks they might encounter in the line of duty. Bringing them to the United States for treatment presents minimal risk to the public, but it could dramatically improve their chances of survival. They deserve our compassion and the best medical care available.
PHOTOS: Members of the media wait in front of Emory University Hospital after an ambulance carrying American doctor Kent Brantly, who has the Ebola virus, arrived via Dobbins Air Reserve Base in Atlanta, Georgia August 2, 2014. REUTERS/Tami Chappell
Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in Kailahun July 20, 2014. REUTERS/Tommy Trenchard